Provider Demographics
NPI:1114787983
Name:SMITH, EULANDA S
Entity Type:Individual
Prefix:
First Name:EULANDA
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10113 FIELDCREST WALK
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2035
Mailing Address - Country:US
Mailing Address - Phone:678-532-0005
Mailing Address - Fax:
Practice Address - Street 1:2518 RIVERTON DR
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-7436
Practice Address - Country:US
Practice Address - Phone:678-532-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide